Spontaneous massive hemoperitoneum: A potentially life threatening presentation of the wandering spleen

Abstract

Context:Wandering spleen is an unusual condition characterized by the absence or maldevelopment of one or all of the ligaments securing the spleen in its normal position in the left upper abdomen. Pedicular tortion with a complete vascular disruption is a rare but known potential complication of this mostly congenital disorder. Spontaneous hemoperitoneum with acute abdomen however, is a life threatening situation that has not been adequately reported in the adult literature.Case Report:A forty four year old man presented to the emergency department with an acutely distended and rigid abdomen. His past medical history was only significant for mild mental retardation. The patient denies prior abdominal operation or recent trauma. On initial examination, he appeared to be anxious, pale, and tachycardic. Fullness in the midpelvic region was easily appreciated on palpation. An enlarged pelvic spleen and free intraperitoneal fluid consistent with blood were seen on a CT scan. The patient was promptly taken for an exploratory laparotomy where a large rush of blood was encountered upon entering the abdomen. A volvulus of the splenic pedicle with an infarcted spleen was found mandating a splenectomy.Conclusions:Abnormally located spleen, splenomegaly, and finding of hemoperitoneum are highly suggestive of wandering spleen with tortioned pedicle. Despite its life threatening presentation, immediate laparotomy and splenectomy invariably result in good outcome.

The Case of the Wandering Spleen

“…A CT scan of the abdomen and pelvis using only intravenous contrast was performed since the patient could 472392J DMXXX10.1177/8756479312472392Journ al of Diagnostic Medical SonographyJones et al 1 University of Arkansas, Fort Smith, AR, USA not tolerate oral contrast. The CT images revealed a dilated stomach with air and fluid present, pneumatosis of the gastric wall, and pneumoperitoneum (Figure 4).…”

“…The ability of the spleen to reposition inside the abdomen is due to the absence, underdevelopment, or laxity of the suspensory ligaments required to fixate it to its normal position in the left upper quadrant. 1 The occurrence of a wandering spleen is rare, and its incidence has been reported to be less than 0.2%. 2 Nearly one-third of all cases of wandering spleen occur in young girls older than 1 year.…”

Laparoscopic Transperitoneal Left Adrenalectomy and Wandering Spleen Risk

“…The progressive splenic enlargement can lead to rare splenic ruptures and to possible spontaneous massive hemoperitoneum. 24 WS can also be an unusual cause of thrombocytopenia. 25 …”